serving on all advisory and program review committees so that the makeup of these committees reflects the changing diversity of the U.S. population. NCI should develop an evaluation plan to assess the effect of increased and more diversified ethnic minority community and researcher input on changes in NCI policies and priorities toward ethnic minority cancer issues.
Such increased and more widely based minority community and researcher input is not the desired end result but is one of many means of marshaling the considerable resources of NCI in reducing the burden of cancer among minorities and medically underserved individuals in terms of fewer deaths, fewer new cases, increased lengths of survival, and increased quality of life among cancer survivors. Such input at least ensures that ethnic minority and medically underserved populations will have a (substantial) voice at all levels of discussion in NCI's agenda. The committee believes that the impact of such a policy shift should be assessed to determine whether it will ultimately have a significant effect on NCI's policies and priorities.
Recommendation 4-2: The research needs of ethnic minority and medically underserved groups should be identified on the basis of the burden of cancer in these populations, with an assessment of the most appropriate areas of research (i.e., behavioral and social sciences, biology, epidemiology and genetics, prevention and control, treatment, etc.).
Another aspect of the potential influence of minority community and researcher input into NCI is the environment within which such input operates. NIH and NCI operate within a primary milieu of "greatest scientific opportunity." In the words of NCI's director: "The NCI's cancer research funding strategy is to assure that there is sufficient funding to enable scientists to pursue those research areas with the greatest scientific opportunity—that is, the greatest opportunity to increase our knowledge of cancer" (National Cancer Institute, 1998d, p. 26).
However, the director also acknowledges that "a second critical factor that guides program direction, in addition to scientific opportunity, is the burden of specific cancers" (National Cancer Institute, 1998d, p. 26). This "second critical factor" is essential for addressing the cancer problems of minority and medically underserved populations because NCI has acknowledged that ''while we have seen a decline in overall cancer prevalence and mortality rates in the last five years, the decline did not occur in all American populations. Overall rates do reflect a story of success based on statistical averages, but when we examine specific ethnic and racial groups, and